Healthcare Provider Details

I. General information

NPI: 1194856419
Provider Name (Legal Business Name): MIRIAM ELENA DE JESUS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2634 CAPITAL CIR NE
TALLAHASSEE FL
32308-4106
US

IV. Provider business mailing address

1112 S MAGNOLIA DR #5101
TALLAHASSEE FL
32301-4673
US

V. Phone/Fax

Practice location:
  • Phone: 850-523-3333
  • Fax: 850-523-3411
Mailing address:
  • Phone: 407-657-1392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberARNP1385482
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP1385482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: